Mailing colorectal cancer screening tests to patients insured by Medicaid increased screening rates for this population, report researchers at the University of North Carolina Comprehensive Cancer Center.

Reseachers examined the impact of targeted outreach to more than 2,100 people insured by Medicaid who were not up-to-date with colorectal cancer screening.

The project resulted in a nearly 9 percentage point percent increase in screening rates for patients who received a screening kit in the mail compared with patients who just received a reminder, and it demonstrated that their method could serve as a model to improve screening on a larger scale. The findings were published in the journal Cancer.

While colorectal cancer screening has proven effective in reducing cancer deaths, researchers report too few people are getting screened. Current guidelines from ACS recommend regular screening with either a high-sensitivity stool-based test or a structural (visual) exam for average-risk people aged 45 years and older, and that all positive results should be followed with colonoscopy.

"There has been a national push to increase colorectal cancer screening rates since colorectal cancer is a preventable disease, but screening rates are only about 63%, and low-income, and otherwise vulnerable populations, tend to be screened at even lower rates," said the study's first author Alison Brenner. 

Fecal immunochemical test

For the project, researchers either mailed reminders about colorectal cancer screening and instructions on how to arrange one with the health department, or reminders plus a fecal immunochemical test, or FIT kit, which can detect blood in the stool—a symptom of colon cancer. The patient completes the test at home and returns it to a provider for analysis. Patients who have a positive FIT kit result will be scheduled for a colonoscopy.

Twenty-one percent of patients who received FIT kits in the mail completed the screening test, compared with 12% of patients who just received a reminder. Eighteen people who completed FIT tests had abnormal results, and 15 of those people were eligible for a colonoscopy. Of the 10 who completed the colonoscopy, one patient had an abnormal result.

"Preventive care amongst vulnerable populations rarely rises to the top of the mental queue of things that need to get done," Brenner said. "In North Carolina, many Medicaid recipients are on disability. Making something like colorectal cancer screening as simple and seamless as possible is really important. If it's right in front of someone, it's more likely to get done, even if there are simple barriers in place."

"This collaborative and pragmatic quality improvement effort demonstrates the feasibility, acceptability, and efficiency of using existing health services resources and infrastructure, including Medicaid-based navigation to colonoscopy to deliver timely cancer screening services to low-income populations," said Stephanie Wheeler, the study's senior author.